Conversion therapy

Conversion therapy is the pseudoscientific practice of trying to change an individual's sexual orientation from homosexual or bisexual to heterosexual using psychological or spiritual interventions. There is virtually no reliable evidence that sexual orientation can be changed and medical bodies warn that conversion therapy practices are ineffective and potentially harmful. Medical, scientific, and government organizations in the United States and United Kingdom have expressed concern over the validity, efficacy and ethics of conversion therapy. Various jurisdictions in Asia, Europe, Oceania, and the Americas have passed laws against conversion therapy. The American Psychiatric Association (APA) opposes psychiatric treatment 'based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her sexual homosexual orientation' and describes attempts to change sexual orientation by practitioners as unethical. It also states that debates over the integration of gay and lesbian people have obscured science 'by calling into question the motives and even the character of individuals on both sides of the issue' and that the advancement of conversion therapy may cause social harm by disseminating unscientific views about sexual orientation. United States Surgeon General David Satcher in 2001 issued a report stating that 'there is no valid scientific evidence that sexual orientation can be changed'. The highest-profile advocates of conversion therapy today tend to be fundamentalist Christian groups and other organizations which use a religious justification for the therapy rather than speaking of homosexuality as 'a disease'. The main organization advocating conversion therapy is the National Association for Research & Therapy of Homosexuality (NARTH), which, although notionally secular, often partners with religious groups. Techniques used in conversion therapy in the United States and Western Europe have included ice-pick lobotomies; chemical castration with hormonal treatment; aversive treatments, such as 'the application of electric shock to the hands and/or genitals'; 'nausea-inducing drugs ... administered simultaneously with the presentation of homoerotic stimuli'; and masturbatory reconditioning. More recent clinical techniques used in the United States have been limited to counseling, visualization, social skills training, psychoanalytic therapy, and spiritual interventions such as 'prayer and group support and pressure', though there are some reports of aversive treatments through unlicensed practice as late as the 1990s. The term reparative therapy has been used as a synonym for conversion therapy in general, but it has been argued that strictly speaking it refers to a specific kind of therapy associated with the psychologists Elizabeth Moberly and Joseph Nicolosi. The history of conversion therapy can be divided broadly into three periods: an early Freudian period; a period of mainstream approval of conversion therapy, when the mental health establishment became the 'primary superintendent' of sexuality; and a post-Stonewall period where the mainstream medical profession disavowed conversion therapy. During the earliest parts of psychoanalytic history, analysts granted that homosexuality was non-pathological in certain cases, and the ethical question of whether it ought to be changed was discussed. By the 1920s analysts assumed that homosexuality was pathological and that attempts to treat it were appropriate, although psychoanalytic opinion about changing homosexuality was largely pessimistic. Those forms of homosexuality that were considered perversions were usually held to be incurable. Analysts' tolerant statements about homosexuality arose from recognition of the difficulty of achieving change. Beginning in the 1930s and continuing for roughly twenty years, major changes occurred in how analysts viewed homosexuality, which involved a shift in the rhetoric of analysts, some of whom felt free to ridicule and abuse their gay patients. Sigmund Freud was a physician and the founder of psychoanalysis. Freud stated that homosexuality could sometimes be removed through hypnotic suggestion, and was influenced by Eugen Steinach, a Viennese endocrinologist who transplanted testicles from straight men into gay men in attempts to change their sexual orientation, stating that his research had 'thrown a strong light on the organic determinants of homo-eroticism'. Freud cautioned that Steinach's operations would not necessarily make possible a therapy that could be generally applied, arguing that such transplant procedures would be effective in changing homosexuality in men only in cases in which it was strongly associated with physical characteristics typical of women, and that probably no similar therapy could be applied to lesbianism. Steinach's method was doomed to failure because the immune system rejects transplanted glands, and was eventually exposed as ineffective and often harmful. Freud's main discussion of female homosexuality was the 1920 paper 'The Psychogenesis of a Case of Homosexuality in a Woman', which described his analysis of a young woman who had entered therapy because her parents were concerned that she was a lesbian. Her father wanted this condition changed. In Freud's view, the prognosis was unfavourable because of the circumstances under which she entered therapy, and because homosexuality was not an illness or neurotic conflict. Freud wrote that changing homosexuality was difficult and possible only under unusually favourable conditions, observing that 'in general to undertake to convert a fully developed homosexual into a heterosexual does not offer much more prospect of success than the reverse'. Success meant making heterosexual feeling possible, not eliminating homosexual feelings.